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Introduction: Tobacco smoking is highly prevalent among alcohol and other drugs (AOD) service clients and, despite interest in quitting, abstinence is rarely sustained. Nicotine products may assist after discharge from residential treatment services, but little is known about client receptivity to them. This study examined AOD withdrawal service clients' experiences of two types of nicotine products for smoking cessation post‐discharge, combination nicotine replacement therapy (cNRT) and nicotine vaping products (NVP). Methods: We held semi‐structured telephone interviews with 31 Australian AOD service clients in a clinical trial of a 12‐week smoking cessation intervention using Quitline support plus cNRT or NVP delivered post‐discharge from a smoke‐free residential service. We asked about health and social factors, nicotine cravings, Quitline experience, and barriers and facilitators to cNRT or NVP, then thematically analysed data. Results: cNRT and NVP were described by participants as feasible and acceptable for smoking cessation. For most participants, cost limited cNRT access post study, as did difficulty navigating NVP prescription access. Quitline support was valued, but not consistently used, with participants noting low assistance with NVP‐facilitated cessation. Participants considered both cessation methods acceptable and socially supported, and sought information on decreasing nicotine use via NVP. Discussion and Conclusions: AOD service clients highly valued receiving cNRT or NVP with behavioural support for smoking reduction or abstinence. Both interventions were acceptable to service clients. Findings suggest a potential need to examine both whether NVP use should be permitted in this context, and guidance on the individual suitability of cNRT or NVP. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between vaping and health behaviors (physical activity, fruit and vegetable consumption, sleep, cigarette use, alcohol consumption) and mental health among college students. Methods: Socio-demographic characteristics, vaping, health behaviors, perceived stress, and depressive symptoms of undergraduates enrolled at a large university located in the Northeast of the United States were assessed via an online survey. Results: Of all participants (n = 1775), less than a fifth (n = 314, 17.7%) reported any vaping in the past month. More men reported vaping than women (23.2% vs. 14.5%). Those who vaped reported fewer nights of restful sleep and greater alcohol consumption. Those who smoked and binge drank were more likely to report vaping. Perceived stress was greater among women who vaped, and depressive symptoms were greater among those who vaped regardless of gender. Conclusions: Vaping was associated with smoking, alcohol consumption, and poorer mental health among young adults. [ABSTRACT FROM AUTHOR]

Aims To examine the relationship between prenatal alcohol exposure (PAE) and children's behavioural and emotional development in a large generalizable sample of women and their children in Aotearoa New Zealand. Methods Using data from the Growing Up in New Zealand longitudinal cohort, we investigated the relationship between maternal PAE and behavioural and emotional development in 8-year-old children. We explored secondary outcomes including measures of language, executive function, academic achievement, and adaptive behaviour. Results We found no significant differences in the measures of behavioural and emotional development in children 8 years old based on alcohol consumption. No significant differences in behavioural and emotional development were found based on amount of PAE and when PAE occurred, despite controlling for a range of potential confounding factors, such as neighbourhood deprivation and maternal health measures. PAE was associated with significantly higher scores for parent-rated oral language indicating better oral language. In Māori mothers, PAE was significantly associated with an increased risk of higher scores on two of the Strengths and Difficulties Questionnaire subscales. Conclusions We did not find an association between PAE and behavioural and emotional development in children aged 8 years. PAE and behavioural and emotional development are difficult to measure accurately, and the moderating variables between them are complex. Future analyses will require larger cohorts of mothers and their children using precise measures of PAE and outcomes to enable more precise estimates of association. [ABSTRACT FROM AUTHOR]

Background—Despite global efforts to control tobacco use, smoking remains a leading cause of preventable diseases, mortality, and disparities, especially among individuals with mental health conditions. Smartphone apps have emerged as cost-effective tools to aid smokers in quitting; however, their evidence-based foundation remains understudied. This research conducted two searches to identify relevant apps: one through the scientific literature and the other from app stores. Methods—The study sought apps designed to assist smokers with mental health conditions in quitting. Searches were conducted in the scientific literature and major app stores. The apps found were evaluated for their basis in theory, features, and claimed effectiveness. Usage and rating scores were compared. Results—Among 23 apps found from app store search, only 10 (43%) were evidence-based and none had explicit reference to theory, while all apps identified in the literature were developed by applying theory. However, app store apps had significantly higher user numbers and ratings than those identified in the literature (mean rating 4.7 out of 5.0). Conclusion—Smokers with mental health conditions have limited support from currently available smoking cessation apps. Apps identified in the scientific literature lack sufficient use and longevity. Sustained support beyond research projects is crucial for enabling theoretically informed evidence-based apps to be available for people with mental health conditions, as is greater collaboration between developers and researchers to create apps that engage with end-user design. [ABSTRACT FROM AUTHOR]

Background: Combining short-acting nicotine replacement therapy with varenicline increases smoking cessation rates compared with varenicline alone, but not all people tolerate these medications or find them helpful. We aim to investigate the therapeutic potential of an analogous combination, by evaluating the effectiveness, safety, and acceptability of combining nicotine salt e-cigarettes with cytisine, compared to nicotine salt e-cigarettes or cytisine only, on smoking abstinence at six months. Methods: A pragmatic, community-based, investigator-blinded, randomised superiority trial design will be utilised. Eligible participants will be people who smoke daily (N = 800, 90% power) from throughout New Zealand, who are: aged ≥ 18 years, motivated to quit in the next two weeks, able to provide online consent, willing to use e-cigarettes and/or cytisine, and have daily access to a mobile phone. Recruitment will utilise multi-media advertising. Participants will be randomised (3:3:2 ratio) to 12 weeks of: 1) e-cigarettes (closed pod system, 3% nicotine salt, tobacco flavour) plus cytisine; 2) e-cigarettes alone, or 3) cytisine alone. All groups will receive a six-month, text-message-based behavioural support programme. The primary outcome is self-reported, biochemically verified, continuous abstinence at six months post-quit date. Secondary outcomes, measured at quit date, then one, three, six, and 12 months post-quit date, include self-reported continuous abstinence, 7-day point prevalence abstinence, cigarettes smoked per day, withdrawal and urge to smoke, time to (re)lapse, treatment use and compliance, treatment crossover, dual-use, use of other cessation products, change in e-cigarette products, continuation of product use, acceptability, change in health state, health-related quality of life, change in body mass index, adverse events, and cost per quitter. Discussion: Pragmatic trials are of particular value as they reflect the 'real world' impact of interventions. The trial will provide some of the first evidence on the effectiveness of combining nicotine salt e-cigarettes with cytisine for smoking cessation, in a country with strong tobacco control policy. Findings will be incorporated into relevant systematic reviews, informing practice and policy. Trial registration: NCT05311085 ClinicalTrials.gov. Registered 5th April, 2022. [ABSTRACT FROM AUTHOR]

Background: Fetal alcohol spectrum disorder (FASD) is a common form of developmental disability but may be poorly understood by professionals working with people with FASD. The aim of the research is to understand the FASD knowledge, attitudes, awareness, and practices among people employed by the education sector in Aotearoa New Zealand and identify gaps in knowledge. Methods: We conducted an online survey of New Zealand Education professionals. The survey focused on the following areas: Awareness of FASD; Knowledge and beliefs about FASD; Impact of FASD on professional practice; and Training needs. Results: Of the 419 participants, most had some knowledge of FASD and its effects on learning; however, there are still gaps that need to be addressed so educators can provide support to individuals living with FASD. Conclusion: There is a need to improve workforce capacity and develop guidelines that address the needs of front-of-line staff working with children with FASD in education settings. [ABSTRACT FROM AUTHOR]

This paper critically analyses a statement by Australia's National Health and Medical Research Council (NHMRC) on e‐cigarettes in May 2022 that will be used to guide national policy. We reviewed the evidence and the conclusions drawn in the NHMRC Statement. In our view, the Statement is not a balanced reflection of the benefits and risks of vaping because it exaggerates the risks of vaping and fails to compare them to the far greater risks of smoking; it uncritically accepts evidence of harms from e‐cigarettes while adopting a highly sceptical attitude towards evidence of their benefits; it incorrectly claims that the association between adolescent vaping and subsequent smoking is causal; and it understates the evidence of the benefits of e‐cigarettes in assisting smokers to quit. The Statement dismisses the evidence that vaping is probably already having a positive net public health effect and misapplies the precautionary principle. Several sources of evidence supporting our assessment were published after the NHMRC Statement's publication and are also referenced. The NHMRC Statement on e‐cigarettes does not present a balanced assessment of the available scientific literature and fails to meet the standard expected of a leading national scientific body. [ABSTRACT FROM AUTHOR]

Aims: This study aims to compare biomarkers of potential harm between people switching from smoking combustible cigarettes (CC) completely to electronic cigarettes (EC), continuing to smoke CC, using both EC and CC (dual users) and using neither (abstainers), based on behaviour during EC intervention studies. Design: Secondary analysis following systematic review, incorporating inverse variance random‐effects meta‐analysis and effect direction plots. Setting: This study was conducted in Greece, Italy, Poland, the United Kingdom and the United States. Participants: A total of 1299 adults smoking CC (nine studies) and provided EC. Measurements Measurements were conducted using carbon monoxide (CO) and 26 other biomarkers. Findings In pooled analyses, exhaled CO (eCO) was lower in EC versus EC + CC [mean difference (MD) = −4.40 parts per million (p.p.m.), 95% confidence interval (CI) = −12.04 to 3.24, two studies] and CC (MD = −9.57 p.p.m., 95% CI = −17.30 to −1.83, three studies). eCO was lower in dual users versus CC only (MD = −1.91 p.p.m., 95% CI = −3.38 to −0.45, two studies). Magnitude rather than direction of effect drove substantial statistical heterogeneity. Effect direction plots were used for other biomarkers. Comparing EC with CC, 12 of 13 biomarkers were significantly lower in EC users, with no difference for the 13th. Comparing EC with dual users, 12 of the 25 biomarkers were lower for EC, and five were lower for dual use. For the remaining eight measures, single studies did not detect statistically significant differences, or the multiple studies contributing to the outcome had inconsistent results. Only one study provided data comparing dual use with CC; of the 13 biomarkers measured, 12 were significantly lower in the dual use group, with no statistically significant difference detected for the 13th. Only one study provided data on abstainers. Conclusions: Switching from smoking to vaping or dual use appears to reduce levels of biomarkers of potential harm significantly. [ABSTRACT FROM AUTHOR]

Under this Act, vaping products manufactured from tobacco can be legally sold in New Zealand, without a doctor's prescription. The Act seeks to strike a balance between ensuring vaping products are available for smokers who want to quit smoking by switching to a less harmful nicotine delivery alternative, and ensuring these products aren't marketed or sold to young people. Keywords: cigarette; vaping EN cigarette vaping 1295 1297 3 07/10/23 20230701 NES 230701 So long as there is a tobacco epidemic, every country should regulate for control of tobacco and nicotine. [Extracted from the article]

Prenatal exposure to alcohol (PAE) represents a significant public health concern. Previous research linking PAE to neurodevelopmental outcomes has been mixed and often has limited focus on residual confounding or moderating factors. A systematic review of prospective cohort studies (n = >1000) assessing the impact of PAE on neurodevelopmental outcomes was undertaken (neurophysiology, motor skills, cognition, language, academic achievement, memory, attention, executive function, affect regulation, and adaptive behaviour, social skills, or communication). Electronic searches of EMBASE, Medline, CINAHL, and Psychinfo were conducted in May 2021. A quality assessment was conducted using an adapted version of the Newcastle-Ottawa Scale (NOS). Thirty longitudinal cohort studies met the inclusion criteria. Evidence of the impact of PAE was mixed across domains. We found no evidence that PAE affects executive function, but there were impacts on motor skills, cognition, language, academic achievement, attention, affect regulation, and adaptive behaviour. The most consistent adverse effect was on affect regulation (nine out of thirteen studies, six of which found an association between heavy alcohol consumption or binge drinking during pregnancy). We found no protective factors. Few studies controlled for variables in the postnatal environment. This review was unable to conclude a safe level of alcohol consumption during pregnancy. Methodological improvements are needed to improve the quality and consistency in which PAE is studied. Further research into residual confounding variables is vital, including a greater focus on the postpartum environment. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has brought the combined disciplines of public health, infectious disease and policy modelling squarely into the spotlight. Never before have decisions regarding public health measures and their impacts been such a topic of international deliberation, from the level of individuals and communities through to global leaders. Nor have models-developed at rapid pace and often in the absence of complete information-ever been so central to the decision-making process. However, after nearly 3 years of experience with modelling, policy-makers need to be more confident about which models will be most helpful to support them when taking public health decisions, and modellers need to better understand the factors that will lead to successful model adoption and utilization. We present a three-stage framework for achieving these ends. [ABSTRACT FROM AUTHOR]

Introduction: Tobacco harm reduction has potential to improve individual and population health. However, little research exists on low-intensity interventions, such as encouraging longer-term NRT or e-cigarette use. We aimed to determine whether: (1) encouraging use of nicotine products as long-term tobacco substitutes is more effective for smoking abstinence than standard treatment, and (2) offering e-cigarettes is more effective than NRT.Methods: An open-label, parallel-group randomized trial was conducted in Australia between 2014 and 2015, with 1563 adult daily smokers, randomized to: (A) standard cessation advice and NRT: advice to use NRT short-term, (B) quit or substitute advice and NRT: advice to use NRT as a longer-term substitute for smoking if required to maintain smoking cessation, or (C) Quit or substitute advice and NRT and/or e-cigarettes. Participants were offered an initial supply of products they could then purchase for up to 7 months. The primary outcome was self-reported continuous smoking abstinence at 7 months. Point prevalence, dual use, and cigarette reduction were secondary outcomes.Results: At 7 months, 2.8% (N = 9) of group A (N = 324) were abstinent, compared with 1.8% (N = 11) in B (N = 620) and 1.3% (N = 8) in C (N = 619) (adjusted odds ratio [ORs]: B vs. A 0.66, 95% confidence interval [CI]: 0.27-1.63; C vs. A 0.46, 95% CI: 0.17-1.21; C vs. B 0.69, 95% CI 0.27-1.73). There were no suspected unexpected serious adverse reactions associated with trial products.Conclusion: A free trial of NRT and first generation e-cigarettes and advice on long-term substitution was no better for smoking abstinence than usual care.Clinical Trial Registration: The trial was registered with the Australian Therapeutic Goods Administration under their Clinical Trials Notification scheme and the Australian and New Zealand Clinical Trials Registry (ACTRN12612001210864).Implications: This pragmatic trial allowed the comparison of existing and alternative policy options under semi-realistic conditions, such as product choice and financial cost. All trial arms had low rates of smoking cessation. The findings suggest that providing unflavored cigalike e-cigarettes without additional support may not increase quitting compared with advice to use standard NRT in a general population of Australians who smoke. More intensive support and education, and/or opportunity to try a range of e-cigarette products, may be required to motivate quit attempts using e-cigarettes. [ABSTRACT FROM AUTHOR]

New Zealand has a strategy of eliminating SARS-CoV-2 that has resulted in a low incidence of reported coronavirus-19 disease (COVID-19). The aim of this study was to describe the spread of SARS-CoV-2 in New Zealand via a nationwide serosurvey of blood donors. Samples (n = 9806) were collected over a month-long period (3 December 2020–6 January 2021) from donors aged 16–88 years. The sample population was geographically spread, covering 16 of 20 district health board regions. A series of Spike-based immunoassays were utilised, and the serological testing algorithm was optimised for specificity given New Zealand is a low prevalence setting. Eighteen samples were seropositive for SARS-CoV-2 antibodies, six of which were retrospectively matched to previously confirmed COVID-19 cases. A further four were from donors that travelled to settings with a high risk of SARS-CoV-2 exposure, suggesting likely infection outside New Zealand. The remaining eight seropositive samples were from seven different district health regions for a true seroprevalence estimate, adjusted for test sensitivity and specificity, of 0.103% (95% confidence interval, 0.09–0.12%). The very low seroprevalence is consistent with limited undetected community transmission and provides robust, serological evidence to support New Zealand's successful elimination strategy for COVID-19. [ABSTRACT FROM AUTHOR]

The Lancet COVID-19 Commission Task Force for Public Health Measures to Suppress the Pandemic was launched to identify critical points for consideration by governments on public health interventions to control coronavirus disease 2019 (COVID-19). Drawing on our review of published studies of data analytics and modelling, evidence synthesis and contextualisation, and behavioural science evidence and theory on public health interventions from a range of sources, we outline evidence for a range of institutional measures and behaviour-change measures. We cite examples of measures adopted by a range of countries, but especially jurisdictions that have, thus far, achieved low numbers of COVID-19 deaths and limited community transmission of severe acute respiratory syndrome coronavirus 2. Finally, we highlight gaps in knowledge where research should be undertaken. As countries consider long-term measures, there is an opportunity to learn, improve the response and prepare for future pandemics. [ABSTRACT FROM AUTHOR]

Introduction: Physiologically based pharmacokinetic (PBPK) models for the absorption, disposition, metabolism and excretion (ADME) of nicotine and its major metabolite cotinine in pregnant women (p-PBPK) are rare. The aim of this short research report is to present a p-PBPK model and its simulations for nicotine and cotinine clearance. Methods: The maternal-placental-fetal compartments of the p-PBPK model contain a total of 16 compartments representing major maternal and fetal organs and tissue groups. Qualitative and quantitative data of nicotine and cotinine disposition and clearance have been incorporated into pharmacokinetic parameters. Results: The p-PBPK model reproduced the higher clearance rates of nicotine and cotinine in pregnant women than non-pregnant women. Temporal profiles for their disposition in organs such as the brain were also simulated. Nicotine concentration reaches its maximum value within 2 min after an intravenous injection. Conclusion: The proposed p-PBPK model produces results consistent with available data sources. Further pharmacokinetic experiments are required to calibrate clearance parameters for individual organs, and for the fetus. [ABSTRACT FROM AUTHOR]

Most countries have implemented restrictions on mobility to prevent the spread of Coronavirus disease-19 (COVID-19), entailing considerable societal costs but, at least initially, based on limited evidence of effectiveness. We asked whether mobility restrictions were associated with changes in the occurrence of COVID-19 in 34 OECD countries plus Singapore and Taiwan. Our data sources were the Google Global Mobility Data Source, which reports different types of mobility, and COVID-19 cases retrieved from the dataset curated by Our World in Data. Beginning at each country's 100th case, and incorporating a 14-day lag to account for the delay between exposure and illness, we examined the association between changes in mobility (with January 3 to February 6, 2020 as baseline) and the ratio of the number of newly confirmed cases on a given day to the total number of cases over the past 14 days from the index day (the potentially infective 'pool' in that population), per million population, using LOESS regression and logit regression. In two-thirds of examined countries, reductions of up to 40% in commuting mobility (to workplaces, transit stations, retailers, and recreation) were associated with decreased cases, especially early in the pandemic. Once both mobility and incidence had been brought down, further restrictions provided little additional benefit. These findings point to the importance of acting early and decisively in a pandemic. [ABSTRACT FROM AUTHOR]

Introduction: Health authorities are advising smokers to quit to reduce their COVID-related risk. The types of messages that may be effective in alerting smokers to this risk and encouraging a quit attempt are unknown. The aim of this study was to test a series of messages to identify potentially effective communication approaches.Methods: An online survey was completed by 1509 smokers across three countries (Australia: n = 604; New Zealand: n = 304; United Kingdom: n = 601) in April-May 2020. Respondents were randomly assigned to view just one of four quit messages, two of which explicitly referred to the coronavirus, one referred to risk of chest infection, and one encouraged cessation for financial reasons. Outcome variables included quit intentions, further information seeking, message perceptions, and health and financial concerns.Results: All four messages were associated with significant differences in the proportions of respondents intending to quit within the following 2 wk (increase range: 11%-34%) and with substantial proportions of respondents electing to access additional information (range: 37%-50%). The differences in intentions were significantly larger for the two health-related messages that specifically mentioned the coronavirus. All messages were perceived favorably in terms of acceptability, believability, effectiveness, and personal relevance. Negligible differences in health and financial concerns were observed.Conclusions: Smokers in Australia, New Zealand, and the United Kingdom appear likely to be receptive to messages about their COVID-related risk. Such messages have the potential to increase quit intentions and prompt information-seeking behaviors.Implications: The COVID-19 pandemic represents an opportunity to encourage smokers to quit to reduce both their COVID-related risks and their risks of a broad range of noncommunicable diseases. [ABSTRACT FROM AUTHOR]

Both housing structure and occupant use of homes influence health outcomes and carbon emissions. However, it remains unclear how these elements interact. We conducted semi-structured interviews with 13 technical experts in the New Zealand housing and health sectors. We applied the general inductive method for qualitative data analysis and generated frameworks for 'housing structure' and 'occupant behaviour' including: (i) issues or barriers, (ii) solutions or facilitators and (iii) potential interventions. Addressing the location, aspect and design of the house were seen to offer the greatest gains in energy efficiency, indoor temperature and air quality. Insulation, heating and ventilation were the most critical technologies for promoting health. Raising consumer expectations of housing standards was thought to be critical to boost demand and drive supply for better quality housing. Participants proposed that sharing personal stories, combining information with active strategies (demonstration, skill rehearsal) and providing incentives were promising strategies to realise the full potential of health-enhancing home design. Schools and the local community were identified as suitable settings. We conclude that public health interventions should not only aim to build homes that maximise health and environmental outcomes but must also pay attention to how occupants behave and interface with their houses. [ABSTRACT FROM AUTHOR]

Background: Mobile devices provide new opportunities for the prevention of overweight and obesity in children. We aimed to co-create and test an app that offered comprehensible feedback to parents on their child's growth and delivered a suite of age-specific information about nutrition and activity. Methods: A two-phased approach was used to co-create the digital growth tool—See How They Grow—and test its feasibility. Phase one used focus groups (parents and professionals such as paediatricians and midwives) and a national on-line survey to gather requirements and build the app. Phase two involved testing the app over 12-weeks, with parents or carers of children aged ≤ 2-years. All research activities were undertaken exclusively through the app, and participants were recruited using social media and hard copy materials given to patents at a child health visit. Findings: Four focus groups and 101 responses to the national survey informed the features and functions to include in the final app. Two hundred and twenty-five participants downloaded the app, resulting in 208 eligible participants. Non-Māori/Non-Pacific (78%) and Māori (14%) had the highest downloads. Fifty-four per cent of participants were parents of children under 6-months. These participants were more likely to regularly use the app than those with children older than 6-months (64% vs 36%, P = 0.011). Over half of the participants entered three measures (n = 101, 48%). Of those that completed the follow-up survey (n = 101, 48%), 72 reported that the app helped them better understand how to interpret growth charts. Conclusion: The app was acceptable and with minor modifications, has the potential to be an effective tool to support parents understanding of growth trajectories for their children. A larger trial is needed to evaluate if the app can have a measurable impact on increasing knowledge and behaviour, and therefore on preventing childhood overweight and obesity. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The prevalence of cancer in the community is likely to be increasing due to an ageing population, implementation of cancer screening programmes and advances in cancer treatment. AIM: To determine the prevalence of primary invasive cancers in a large general practice patient population in New Zealand and to characterise the health-care status of these cancer patients. METHODS: Data were sourced from the patient management system of a large general practice (n = 11,374 patients) in a medium-sized Waikato town and from the New Zealand Cancer Registry dataset to identify patients diagnosed with cancer between January 2009 and December 2018. RESULTS: There were 206 cancer diagnoses in 201 patients; 35 cancers were diagnosed in 1887 Māori patients (1.9%) and 171 in 9487 non-Māori patients (1.8%). The age-standardised prevalence was 3092/100,000 in Māori patients and 1971/100,000 in non-Māori patients. The most prevalent cancers were breast, male genital organ, digestive organ and skin cancers. In May 2019, 81 of 201 (40.8%) patients with cancer were receiving only usual care from their general practitioner, whereas 66 (32.8%) were having their cancer managed in secondary care. Comorbidities were common, including hypertension (38.8%), gastrointestinal disorders (29.9%) and mood disorders (24.4%). DISCUSSION: Results suggest that there may be disparities in cancer prevalence between Māori and non-Māori patients, although this needs to be confirmed in other general practices. Furthermore, primary care appears to be responsible for most of the care in this patient cohort and workloads should be planned accordingly, particularly with the high incidence of comorbidities. [ABSTRACT FROM AUTHOR]

Background: Betel nut chewing is a public health concern in the Asia-Pacific region and is an emerging issue in Vanuatu. Despite the significant health risks associated with betel nut chewing, few interventions have been undertaken to reduce its harm. Objectives: To investigate betel nut use in Vanuatu and to identify opportunities to reduce its harm and possible interventions, framing the responses using the World Health Organization's MPOWER tobacco control model. Method: Qualitative research design, in the form of semi-structured interviews with ten participants with expertise in health, agriculture, education or non-communicable disease in Port Vila, Vanuatu during June 2017. Recorded interviews were transcribed verbatim, and a general inductive approach was used to identify key themes. Results: Participants reported a recent increase in betel nut use in Vanuatu due to the influence from Papua New Guinea and the Solomon Islands. To reduce the harm of betel nut use in Vanuatu, participants suggested policies and strategies that aligned with the MPOWER framework that could be adopted for betel nut control, including restricting cultivation and sale of betel nut in Vanuatu and using radio and existing community networks to reach people with messages about the dangers of betel nut use. Conclusion: Betel nut use may be growing in popularity in Vanuatu, where there are potential policy options to minimize harm. The MPOWER model for tobacco control may be a useful framework to help the Vanuatu government to deliver a comprehensive approach to reducing harm from betel nut use. [ABSTRACT FROM AUTHOR]

Background: Betel nut use is a public health issue in the Asia-Pacific region that is often neglected. To control betel nut use, understanding of the adverse effects of betel nut use and evidence-based policies and strategies is necessary. Objectives: This narrative review aims to characterize the current situation on betel nut use at a global level regarding the epidemiology, pharmacology and toxicology, health effects, treatment options, policies and strategies. Methods: We found 139 existing literature published between 1970–2019 on the Web of Science database and other technical documents to collate the most relevant information on betel nut use. Data were categorized into appropriate themes. Results: The literature demonstrates that there is a lack of up to date statistics on betel nut use. There is limited research on the effect of policies and strategies to control betel nut use. Conclusion: Betel nut-chewing countries should focus on understanding which populations chew betel nut and implement appropriate policies, educational and cessation programs to help control betel nut use. [ABSTRACT FROM AUTHOR]

Objective To determine the effect of a keratin dressing for treating slow-to-heal venous leg ulcers (VLU) on VLU healing. Design Pragmatic parallel group randomised controlled trial. Setting Community-dwelling participants. Participants People aged 18 or more years with VLU (either present for more than 26 weeks or ulcer area larger than 5 cm² or both). Intervention Wool-derived keratin dressing or usual care formulary of non-medicated dressings, on a background treatment with compression. Primary and secondary outcome measures Healing at 24 weeks based on blinded assessment of ulcer photographs. Other outcomes included time to complete healing, change in ulcer area to 24 weeks, change in health-related quality of life and incidence of adverse events. Results We screened 1068 patients with VLU and randomised 143 participants (51.1% of target recruitment), 71 to the keratin dressing group and 72 to the usual care group. The mean age was 66.1 years (SD 15.9) and 53 participants (37.1%) were women. There were no significant differences between the groups on the primary outcome (risk difference −6.4%, 95% CI −22.5% to 9.7%), change in ulcer area (−1.9 cm², 95% CI −16.5 to 12.8 cm²), time to complete healing (HR 0.80, 95% CI 0.52 to 1.23) or the incidence of adverse events (incidence rate ratio 1.19, 95% CI 0.89 to 1.59) in the intention-to-treat analyses. However, the direction of effect on the primary outcome was reversed in a per protocol analysis specified a priori (risk difference 6.2%, 95% CI −12.4% to 24.9%). Conclusion The effect of adding a keratin dressing to the treatment regimen for prognostically slow-to-heal VLU remains unclear. [ABSTRACT FROM AUTHOR]

Background: The low utilisation of current treatment services by people with gambling problems highlights the need to explore new modalities of delivering treatment interventions. This protocol presents the design of a pragmatic randomized control trial aimed at assessing the effectiveness and acceptability of cognitive behavioral therapy (CBT) delivered via a mobile app for people with self-reported gambling problems.Methods: An innovative CBT mobile app, based on Deakin University's GAMBLINGLESS online program, has been adapted with end-users (Manaaki). Six intervention modules have been created. These are interwoven with visual themes to represent a journey of recovery and include attributes such as avatars, videos, and animations to support end-user engagement. An audio facility is used throughout the app to cater for different learning styles. Personalizing the app has been accomplished by using greetings in the participant's language and their name (e.g. Kia ora Tāne) and by creating personalized feedback. A pragmatic, randomized control two-arm single-blind trial, will be conducted in New Zealand. We aim to recruit 284 individuals. Eligible participants are ≥18 years old, seeking help for their gambling, have access to a smartphone capable of downloading an app, able to understand the English language and are willing to provide follow-up information at scheduled time points. Allocation is 1:1, stratified by ethnicity, gender, and gambling symptom severity based on the Gambling Symptom Assessment Scale (G-SAS). The intervention group will receive the full mobile cognitive behavioural programme and the waitlist group will receive a simple app that counts down the time left before they have access to the full app and the links to the data collection tools. Data collection for both groups are: baseline, 4-, 8-, and 12-weeks post-randomisation. The primary outcome is a change in G-SAS scores. Secondary measures include changes in gambling urges, frequency, expenditure, and readiness to change. Indices of app engagement, utilisation and acceptability will be collected throughout the delivery of the intervention.Discussion: If effective, this study will contribute to the improvement of health outcomes for people experiencing gambling problems and have great potential to reach population groups who do not readily engage with current treatment services.Ethics Approval: NZ Health and Disability Ethics Committee (Ref: 19/STH/204) TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry (ANZCTRN 12619001605189) Registered 1 November 2019. [ABSTRACT FROM AUTHOR]

1. Cytisine, a partial agonist for the α4β2-nAChR, is used as a smoking cessation medication. Cytisine's current dosing is complex and involves taking 1.5 mg several times a day. The aim of this study was to explore the effect of dose on the pharmacokinetics and safety of cytisine after a single dose in healthy adult smokers. 2. Participants were assigned to one of three groups (n = 6 in each group) to receive a single oral dose of 1.5, 3 or 4.5 mg of cytisine. Blood samples were collected up to 24 h post dose. Pulse, blood pressure and respiratory rate were measured. Adverse effects were recorded. 3. Cytisine reached peak plasma concentration 1–2 h post dose in all participants irrespective of dose, with no dose-dependent changes in the elimination phase. Mean (SD) cytisine exposure (AUC0–24h) were 81.9 (15.8), 181.9 (40.8) and 254.5 (48.1) ng.h/mL following 1.5, 3 and 4.5 mg, respectively. 4. Cytisine appears to have predictable pharmacokinetics following a single dose of up to 4.5 mg and may be safe given as a single 4.5 mg dose, which is threefold greater than the recommended dose taken at one time. This study is registered in (ID:NCT02585024). [ABSTRACT FROM AUTHOR]

INTRODUCTION The mobile-phone-based Bedfont iCO™ Smokerlyzer® is of unknown validity and reproducibility compared to the widely-used piCO+ Smokerlyzer®. We aimed to compare the validity and reproducibility of the iCO™ Smokerlyzer® with the piCO+ Smokerlyzer® among patients reducing or quitting tobacco smoking. METHODS Methadone-maintained therapy (MMT) users from three centers in Malaysia had their exhaled carbon monoxide (eCO) levels recorded via the piCO+ and iCO™ Smokerlyzers®, their nicotine dependence assessed with the Malay version of the Fagerström Test for Nicotine Dependence (FTND-M), and daily tobacco intake measured via the Opiate Treatment Index (OTI) Tobacco Q-score. Pearson partial correlations were used to compare the eCO results of both devices, as well as the corresponding FTND-M scores. RESULTS Among the 146 participants (mean age 47.9 years, 92.5% male, and 73.3% Malay ethnic group) most (55.5%) were moderate smokers (6-19 cigarettes/day). Mean eCO categories were significantly correlated between both devices (r=0.861, p<0.001), and the first and second readings were significantly correlated for each device (r=0.94 for the piCO+ Smokerlyzer®, p<0.001; r=0.91 for the iCO™ Smokerlyzer®, p<0.001). Exhaled CO correlated positively with FTND-M scores for both devices. The post hoc analysis revealed a significantly lower iCO™ Smokerlyzer® reading of 0.82 (95% CI: 0.69–0.94, p<0.001) compared to that of the piCO+ Smokerlyzer®, and a significant intercept of -0.34 (95% CI: -0.61 – -0.07, p=0.016) on linear regression analysis, suggesting that there may be a calibration error in one or more of the iCO™ Smokerlyzer® devices. CONCLUSIONS The iCO™ Smokerlyzer® readings are highly reproducible compared to those of the piCO+ Smokerlyzer®, but calibration guidelines are required for the mobile-phone-based device. Further research is required to assess interchangeability. [ABSTRACT FROM AUTHOR]

Introduction Evidence indicates e-cigarettes can help people quit smoking; however, more confirmatory trials are needed. To date, no trials have evaluated the effectiveness and safety of combining nicotine patches with e-cigarettes (with and without nicotine) for smoking cessation. Methods and analysis This study is a pragmatic, three-arm, community-based, single-blind, randomised trial undertaken in New Zealand. Eligible participants are daily/non-daily smokers, aged ≥18 years, naive e-cigarette users and motivated to quit smoking in the next 2 weeks. Participants (n=1809), recruited using multi-media advertising, are randomised to 14 weeks of (1) 21 mg nicotine patches (n=201); (2) 21 mg nicotine patches+18 mg/mL nicotine e-cigarette (n=804); or (3) 21 mg nicotine patches+nicotine free e-cigarette (n=804). Participants receive weekly withdrawal-oriented behavioural support calls for 6 weeks post-randomisation. The primary outcome is self-reported biochemically verified continuous abstinence (CA) at 6 months post quit-date. The primary comparison is nicotine patch + nicotine e-cigarette versus nicotine patch + nicotine free e-cigarette, and the secondary comparison is nicotine patch versus nicotine patch +nicotine e-cigarette (90% power, p=0.05, to detect an absolute difference in 6 month CA rates of 8% and 15% respectively). Secondary outcomes, collected by phone interview at quit date, then 1, 3, 6 and 12 months post-quit date, include self-reported CA, 7 day point prevalence abstinence, cigarettes per day (if smoking, or when smoking for non-daily smokers), time to relapse (if returned to smoking), belief in ability to quit, use of other cessation support, side effects/ serious adverse events, treatment compliance, seeking additional support around e-cigarette use, daily use of both e-cigarettes and cigarettes, use of treatment past 14 weeks, views on treatment and recommendation to others, weight and cost-per-quitter. Ethics and dissemination The Northern A Health and Disability Ethics Committee approved the trial. Findings will be disseminated through publication, conference/meeting presentations, and media. [ABSTRACT FROM AUTHOR]

Background and aims: Cytisine, a nicotinic acetylcholine receptor partial agonist (like varenicline) found in some plants, is a low‐cost, effective smoking cessation medication that may appeal to Māori [the indigenous people of New Zealand (NZ)]. The RAUORA trial aims to determine the effectiveness, safety and cost‐effectiveness of cytisine (Tabex®) versus varenicline (Champix®) for smoking cessation in Māori and the whānau (extended family) of Māori. Design Pragmatic, community‐based, open‐label randomized non‐inferiority trial. Setting: Lakes District Health Board region, NZ. Participants: Daily smokers (n = 2140) who self‐identify as Māori or whānau of Māori, and are: aged ≥ 18 years, motivated to quit smoking in the next 2 weeks, eligible for subsidized varenicline, able to provide verbal consent and have daily access to a mobile phone/internet. Recruitment uses multi‐media advertising. Intervention and comparator: Participants are randomized (1 : 1 ratio) to receive a prescription for 12 weeks of cytisine tablets [following the manufacturer's dosing regimen for 25 days, then one 1.5‐mg tablet every 6 hours (two per day) until 12 weeks] or varenicline tablets (following the manufacturer's dosing regimen). Both groups receive brief stop‐smoking advice from the prescribing doctor and withdrawal‐orientated behavioural support via community‐based stop‐smoking counselling services (frequency, duration and mode of delivery tailored for participants) or a research assistant (six weekly 10–15‐minute calls). Participants are advised to reduce their smoking over the first 4 days of treatment, with day 5 as their designated quit‐date. Measurements The primary outcome is carbon monoxide‐verified continuous abstinence at 6 months post‐quit date. Secondary outcomes at 1, 3, 6 and 12 months post‐quit date include: self‐reported continuous abstinence, 7‐day point prevalence abstinence, cigarettes per day, time to (re)lapse, adverse events, treatment adherence/compliance, treatment acceptability, nicotine withdrawal/urge to smoke and health‐care utilization/health‐related quality of life. Comments This trial compares cytisine and varenicline when used by the indigenous people of NZ and their extended family for smoking cessation. [ABSTRACT FROM AUTHOR]

Background: Risk factors for cardiovascular disease (CVD) are negatively correlated with socio-economic status (SES) in high-income countries (HIC) but there has been little research on their distribution by household SES within low-and middle-income countries (LMICs). Considering the limited data from LMICs, this paper examines the association between behavioural and cardiovascular risk factors and household SES in Papua New Guinea (PNG). Methods: Reported here are results of 671 participants from the 900 randomly selected adults aged 15–65 years. These adults were recruited from three socioeconomically and geographically diverse surveillance sites (peri-urban community, rural Highland and an Island community) in PNG in 2013–2014. We measured their CVD risk factors (behavioural and metabolic) using a modified WHO STEPS risk factor survey and analysis of blood samples. We assessed SES by education, occupation and creating a household wealth index based on household assets. We calculated risk ratios (RR) and their 95% confidence intervals (CI) using a generalized linear model to assess the associations between risks and SES. Findings: Elevated CVD risk factors were common in all SES groups but the CVD metabolic risk factors were most prevalent among homemakers, peri-urban and rural highlands, and the highest (4th and 5th) wealth quintile population. Adults in the highest wealth quintile had high risks of obesity, elevated HbA1c and metabolic syndrome (MetS) that were greater than those in the lowest quintile although those in the highest wealth quintiles were less likely to smoke tobacco. Compared to people from the Island community, peri-urban residents had increased risks of increased waist circumference (WC) (RR: 1.67, 95%CI: 1.21–2.31), hypertension (RR: 2∙29, 95%CI: 1∙89–4.56), high cholesterol (RR: 2∙22, 95%CI: 1∙20–4∙10), high triglycerides (RR: 1∙49, 95%CI: 1∙17–1∙91), elevated HbA1c (RR: 5∙54, 95%CI: 1∙36–21∙56), and Metabolic syndrome (MetS) (RR: 2∙04, 95%CI: 1∙25–3∙32). Similarly, Rural Highland residents had increased risk of obesity (Waist Circumference RR: 1∙70, 95%CI: 1∙21–3∙38, Waist-Hip-Ratio RR:1∙48, 95%CI: 1∙28–1∙70), hypertension (RR: 2∙60, 95%CI: 1∙71–3∙95), high triglycerides (RR: 1∙34, 95%CI: 1∙06–1∙70) and MetS (RR: 1∙88, 95%CI: 1∙12–3∙16) compared to those in the rural Island site. Interpretation: CVD risk factors are common in PNG adults but their association with SES varies markedly and by location. Our findings show that all community members are at risk of CVD weather they are part of high or low SES groups. These results support the notion that the association between CVD risk factors and SES differ greatly accordingly to the type of SES measure used, risk factors and the population studied. In addition, our findings contribute further to the limited literature in LMIC. Longitudinal studies are needed to monitor changes in rapidly changing societies such as PNG to inform public health policy for control and prevention of NCDs in the country. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine the effect of polypill-based care on the achievement of 2016 European Society of Cardiology (ESC) guideline targets for blood pressure (BP), low-density lipoprotein (LDL) cholesterol and antiplatelet therapy.Methods: We conducted an individual participant data meta-analysis of three randomised clinical trials that compared a strategy using a polypill containing aspirin, statin and antihypertensive therapy with usual care in patients with a prior cardiovascular disease (CVD) event or who were at high risk of their first event. Overall, the trials included 3140 patients from Australia, England, India, Ireland, the Netherlands and New Zealand (75% male, mean age 62 years and 76% with a prior CVD event). The primary outcome for this study was the proportion of people achieving ESC guideline targets for BP, LDL and antiplatelet therapy.Results: Those randomised to polypill-based care were more likely than those receiving usual care to achieve recommended targets for BP (62% vs 58%, risk ratio (RR) 1.08, 95% CI 1.02 to 1.15), LDL (39% vs 34%, RR 1.13, 95% CI 1.02 to 1.25) and all three targets for BP, LDL and adherence to antiplatelet therapy (the latter only applicable to those with a prior CVD event) simultaneously (24% vs 19%, RR 1.27, 95% CI 1.10 to 1.47) at 12 months. There was no difference between groups in antiplatelet adherence (96% vs 96%, RR 1.00, 95% CI 0.98 to 1.01). There was heterogeneity by baseline treatment intensity such that treatment effects increased with the fewer the number of treatments being taken at baseline: for patients taking 3, 2 and 0-1 treatment modalities the RRs for reaching all three guideline goals simultaneously were 1.10 (95% CI 0.94 to 1.30, 22% vs 20%), 1.62 (95% CI 1.09 to 2.42, 27% vs 17%) and 3.07 (95% CI 1.77 to 5.33, 35% vs 11%), respectively.Conclusions: Polypill-based therapy significantly improved the achievement of all three ESC targets for BP, LDL and antiplatelet therapy compared with usual care, particularly among those undertreated at baseline. [ABSTRACT FROM AUTHOR]

Introduction: E-cigarettes have potential to support tobacco cessation or reduction, but how nicotine content affects smokers' subjective perceptions and use of e-cigarettes, rather than tobacco, is unclear.Method: Thirty-five adult daily smokers who had not previously tried e-cigarettes were recruited from two cities in New Zealand in 2016-2017. Smokers were given four e-cigarette cartridges (0, 6, 12, and 18 mg nicotine) in a randomized, blinded order over four 2-week periods. Daily cigarette smoking and e-cigarette use was monitored using ecological momentary analysis and participants completed the modified Cigarette Evaluation Questionnaire after each 2-week period.Results: Mean cigarettes per day decreased by 37% (9.69 to 6.09) when e-cigarettes were available relative to baseline (p = .008). Nicotine-containing cartridges (>0 mg) were associated with greater use (p = .023) and craving reduction (p = .026) than 0 mg. Alleviation of withdrawal symptoms (p = .048) and taste and enjoyment factors (p = .039) predicted e-cigarette use.Conclusion: Availability of e-cigarettes reduced cigarette smoking behavior regardless of nicotine content, and e-cigarette use was greater with nicotine-containing cartridges. First-time users' e-cigarette use can be predicted using subjective ratings and more research is required to clarify the effect of nicotine content on subjective perceptions and use.Implications: For low-moderate dependence smokers, availability of e-cigarettes may reduce cigarette smoking behavior regardless of nicotine content, but the availability of nicotine-containing cartridges may promote greater e-cigarette use. First response to trialing e-cigarettes is an important factor in determining subsequent experimental and possibly longer-term use. [ABSTRACT FROM AUTHOR]

Background: In the Asia-Pacific region, betel quid and areca nut chewing is a public health concern that requires immediate attention. There is a need to improve knowledge about the harmful effects of betel quid and areca nut chewing and train health care professionals to provide preventive interventions. Objectives: To introduce and evaluate the Pacific Open Learning Health Net (POLHN) online courses about the dangers of betel quid and areca nut. Methods: Two self-paced courses about betel quid and areca nut chewing were developed and offered via the POLHN which predominantly engages health professional working in the Pacific islands. Students completing each of the courses were asked to complete a survey measuring course organization, content, length and comprehension level, evaluation methods, adaption to the Pacific island context, relevance to work and level of interaction. Conclusions: The POLHN courses about the dangers of betel quid and areca nut were well accepted by participants for quality and relevancy to their work. POLHN is the first platform that offers a course in betel quid and areca nut in the Pacific and has the potential to be adopted elsewhere. [ABSTRACT FROM AUTHOR]

Aims: The role of health professionals in the provision of harm reduction services is well established in some countries, but not all. We describe a two week course in harm reduction for undergraduate health professionals from a range of countries run in 2014, and provide an account of its evaluation.Methods: Before and after design, with Revised Interprofessional Education Perception Scale (RIEPS) and Harm Reduction Attitude Measurement Scale (HRAS) administered at the start and end of the course, and focus groups at the end of the course to explore perceptions of harm reduction.Findings: Student perceptions of interprofessional learning were generally positive at the start of the course. The only significant change at the end of the course was an improvement in “Perception of Actual Co-operation”. Attitudes towards harm reduction were positive, but there was a significant positive shift in total attitude score at the end of the course. Qualitative analyses indicated that students experienced a shift towards less stigmatising attitudes, and attributed some of this to the experiential visits they attended.Conclusions: An interprofessional harm reduction course can have a positive impact on students’ attitudes towards harm reduction. [ABSTRACT FROM PUBLISHER]

Venous insufficiency is the most common cause of leg ulceration, but the impact of venous leg ulceration on health‐related quality of life has not been adequately assessed. This study compared data from randomized controlled trials to population norms obtained from a large national population survey. We combined the baseline Short Form‐36 (SF‐36) version 1 data from two New Zealand randomized controlled trials that recruited participants with VLU and compared the pooled data to the population scores obtained from the New Zealand Health Survey using general linear regression to adjust for age, sex, and ethnicity differences between the cohorts. Baseline SF‐36 scores obtained from 618 trial participants were compared to the SF‐36 scores obtained from the 12,529 participants in the New Zealand Health Survey. Participants with VLU had significantly lower crude SF‐36 scores across all eight SF‐36 domains, but there was interaction between age and group. Adjusted mean differences for participants aged 65 years or younger were −25.8, −32.1, −21.2, −9.6, −7.6, −23.9, −21.5, and −9.3, respectively, for Physical Functioning, Role Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role Emotional, and Mental Health whereas the adjusted mean differences for older participants were −15.7, −23.8, −13.8, −0.3 (nonsignificant), −4.6, −15.3, −21.2, and −6.6. This study is the first to compare a VLU population to norms from a general population survey and the first to show VLU interacts with age creating stronger impact in younger patients compared their age cohort. Younger patients may have need of more pastoral care as a consequence. [ABSTRACT FROM AUTHOR]

Introduction Keratins, filament-forming proteins found in vertebrate epithelium, are downregulated in slow-healing venous leg ulcers (VLU) compared with normal-healing VLU. Laboratory and animal model research has suggested exogenous keratins increase expression of endogenous keratins. A non-randomised controlled trial of an exogenous keratin dressing reported increased healing in slow-healing VLU. To date, no randomised controlled trial has been done to verify these promising findings. Methods and analysis The Keratin4VLU trial is a single-blind, pragmatic, parallel group, randomised controlled trial of keratin dressings compared with usual care non-medicated dressings in patients with VLU where either (1) the ulcer area is greater than 5 cm², (2) the ulcer has been present for more than 26 weeks or (3) both. All patients will receive compression therapy. The primary outcome is the proportion of patients with healed VLU at 24 weeks after randomisation as adjudicated by blinded review of an ulcer photograph. Secondary outcomes are time to healing, estimated change in ulcer area, change in health-related quality of life, agreement between blinded and unblinded assessors and adverse events. The analysis will be intention-to-treat on the primary and secondary outcomes (excepting health-related quality of life). Ethics and dissemination The Keratin4VLU trial received ethical approval from the Northern A Health and Disability Ethics Committee. We plan to publish the results within 1 year of trial completion and will include the results on the trial registration page. Trial registration number NCT02896725; Pre-results. [ABSTRACT FROM AUTHOR]

Objectives: To assess the effect of a point of care (POC) device for testing lipids and HbA1c in addition to testing by community laboratory facilities (usual practice) on the completion of cardiovascular disease (CVD) risk assessments in general practice. Methods: We conducted a pragmatic, cluster randomised controlled trial in 20 New Zealand general practices stratified by size and rurality and randomised to POC device plus usual practice or usual practice alone (controls). Patients aged 35–79 years were eligible if they met national guideline criteria for CVD risk assessment. Data on CVD risk assessments were aggregated using a web-based decision support programme common to each practice. Data entered into the on-line CVD risk assessment form could be saved pending blood test results. The primary outcome was the proportion of completed CVD risk assessments. Qualitative data on practice processes for CVD risk assessment and feasibility of POC testing were collected at the end of the study by interviews and questionnaire. The POC testing was supported by a comprehensive quality assurance programme. Results: A CVD risk assessment entry was recorded for 7421 patients in 10 POC practices and 6217 patients in 10 control practices; 99.5% of CVD risk assessments had complete data in both groups (adjusted odds ratio 1.02 [95%CI 0.61–1.69]). There were major external influences that affected the trial: including a national performance target for CVD risk assessment and changes to CVD guidelines. All practices had invested in systems and dedicated staff time to identify and follow up patients to completion. However, the POC device was viewed by most as an additional tool rather than as an opportunity to review practice work flow and leverage the immediate test results for patient education and CVD risk management discussions. Shortly after commencement, the trial was halted due to a change in the HbA1c test assay performance. The trial restarted after the manufacturing issue was rectified but this affected the end use of the device. Conclusions: Performance incentives and external influences were more powerful modifiers of practice behaviours than the POC device in relation to CVD risk assessment completion. The promise of combining risk assessment, communication and management within one consultation was not realised. With shifts in policy focus, the utility of POC devices for patient engagement in CVD preventive care may be demonstrated if fully integrated into the clinical setting. Trial registration: Australian New Zealand Clinical Trials Registry [ABSTRACT FROM AUTHOR]